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P - 77024�'j��,� REQUEST FOR ELECTRIC INS ECTION �`'�� 1 9 0 2�'} H� � Minnesota Board of Electricity �`��,�C�r7�] �� ;� ❑ 1821 University Avenue Suite S-128. Sain�Paul, inneso�a �Sd04 ,� � (651) 642-0800 TTYIMRS 1-800-627-3529 xRVH�.electriciry.state.mn.us �� Describe -using fhe back of the white co if �nejcessary - the work covered by this request: . /I �ivT��l > //�i7� f7��///�J�� i!�� / ii�f/ �� .�7/J�� SERViCES / POWER SUPPLIES / 0 to 400 Ampere C� $25 ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL FEES Additionat Unit Traffic Si nal Standard $5 Supplemental Fee $20 Transformers u to 10 KVA $10 Transformers over 10 KVA $ 20 Transformer I Power Su I for Si ns / Outline Li htin $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Additional Ins ction Tri s $20 Investi ative Fee Reins ection fee $20 TOTALFEE ��j (minimum total fee is $20) .Z//. �� I hereby certify that I inspected fhe electrical installation described herein on the dates stated: � Center Pivot Irrigation Boom $40 HO0""'" pA1t Manufactured Home Park Lots $25 Recreational Vehicle Park Sites $5 F�rw� �NSaec.�a, . on.� Se arate Bondin Ins ection $20 -. �� SpBCiel InSp2Ction $30 pC� HOU� exaiaeoiaeaHOONeo on� Special Inspection $.31 per Mile THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS III�I IIIII I�III IIlil III�I IIIII IIIII IIIII n� I�I L902482? uaw: Rou h-in Ins ection Re uired? g p q ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call ��/9� You must call the inspector when ready! Date Ready: �� ' �`� i I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai work ar Job Site Street Address City .��029 ��i�� Vz�i�i�� i�//r G ic[or, company or Co rac� �� L � � �fff Jumbers Inciuding Area Code \ � License Number Master Electrician or � r f �. . icense Number �(2) Phone Numbers Including Area Code "� �